Chronic pulmonary aspergillosis update: A year in review

Barać, Aleksandra; Kosmidis, Chris; Alastruey‐Izquierdo, Ana; Salzer, Helmut J. F.; CPAnet,

doi:10.1093/mmy/myy070

Cited by 57 publications

(46 citation statements)

References 43 publications

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“…Treatment for CCPA is aimed at symptom improvement, to prevent and/or reduce hemoptysis and progression of lung fibrosis. Oral azole therapy with itraconazole (200 mg twice daily with therapeutic drug level monitoring) or voriconazole (150-200 mg twice daily with therapeutic drug level monitoring) is well-established first-line therapy [15,60,61]. Some may favor use of voriconazole in patients with heavy fungal load due to higher reported resistance rate to itraconazole, however, there has been little clinical evidence supporting this approach [15,50].…”

Section: Treatmentmentioning

confidence: 99%

Advances in the Diagnosis and Management of Pulmonary Aspergillosis

Gao

Soubani

2020

Advances in Respiratory Medicine

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Aspergillus is a mould that is ubiquitous in nature and may lead to a variety of infectious and allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients appear to be at an increased risk as well. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic pulmonary aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Recently, the European Society for Clinical Microbiology and Infectious Diseases provided a more robust sub-classification of this entity that allows for a straightforward approach to diagnosis and management. Allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. It also details the role of noninvasive tests in the diagnosis of Aspergillus related lung diseases and advances in the management of these disorders.

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Section: Treatmentmentioning

confidence: 99%

Advances in the Diagnosis and Management of Pulmonary Aspergillosis

Gao

Soubani

2020

Advances in Respiratory Medicine

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“…CPA patients are hampered by a substantial morbidity affecting approximately 3 million people worldwide and with an overall 5-year mortality of up to 80% that estimates 450,000 annual deaths [ 3 , 4 , 5 ]. Despite this apparently high disease burden, paradoxically CPA prevalence seems to be low in single centers [ 6 ]. There might be several explanations for this appearance.…”

Section: Introductionmentioning

confidence: 99%

CPAnet Registry—An International Chronic Pulmonary Aspergillosis Registry

Laursen

Davidsen

Acker

et al. 2020

JoF

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Chronic pulmonary aspergillosis (CPA) is a chronic fungal infection of the lung associated with high morbidity and mortality. The CPA Research network (CPAnet) registry established in 2018 is an international multicenter collaboration aiming to improve CPA knowledge and patient care. This study’s aim was to describe the data collection process and content of CPAnet registry with preliminary clinical data. In the CPAnet registry, clinical data are collected through a web-based questionnaire. Data include CPA phenotype, comorbidities, treatment, outcome, and follow-up from several international centers. An exemplary descriptive analysis was performed on 74 patients, who were registered online before April 2020. CPA patients were predominantly (72%) male, 39% had chronic obstructive pulmonary disease, and 68% had a history of smoking. Chronic cavitary pulmonary aspergillosis was the most common CPA subtype (62%). In 32 patients (52%), voriconazole was the preferred first-line therapy. The multicenter multinational CPAnet registry is a valuable approach to gather comprehensive data on a large study population and reflects real-world clinical practice rather than focusing on specific patient populations in more specialized centers. Additional CPA reference centers are being encouraged to join this promising clinical research collaboration.

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“…According to the clinical characteristics, pulmonary aspergillosis can be divided into allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), invasive pulmonary aspergillosis (IPA), and subacute invasive aspergillosis (SAIA) [3]. Among them, CPA usually occurs in immunocompetent individuals with underlying respiratory disorders, and the prevalence of CPA worldwide is approximately 3 million [4]. Unfortunately, respiratory physicians may not detect CPA until the disease progresses to an advanced stage owing to the lack of specific clinical manifestations.…”

Section: Introductionmentioning

confidence: 99%

Potential value of serum Aspergillus IgG antibody detection in the diagnosis of invasive and chronic pulmonary aspergillosis in non-agranulocytic patients

Xing

et al. 2020

BMC Pulm Med

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Background: At present, serum Aspergillus IgG and IgM antibody detection is mainly used in the diagnosis of chronic pulmonary aspergillosis (CPA), but its value in the diagnosis of invasive pulmonary aspergillosis (IPA) in nonagranulocytic patients is still unclear. IgM can be used as a marker of acute infection to help diagnose acute infection-related diseases. IgG is a marker of long-term infection and is used to assist in the diagnosis of preexisting or chronic infection-related diseases. The aim of this study was to investigate and compare the value of serum Aspergillus IgG and IgM antibody detection in the diagnosis of IPA and CPA in non-agranulocytic patients. Methods: Fifty-eight cases of pulmonary aspergillosis (37 IPA and 21 CPA cases), 15 cases of community-acquired bacterial pneumonia and 50 cases in the healthy control group were collected. The serum (1,3)-β-D-glucan test (G test) was performed with a chromogenic method, and the galactomannan test (GM test) and Aspergillus IgG and IgM antibody detection were performed by commercial enzyme-linked immunosorbent assay (ELISA) in all patients. The sensitivity and specificity, cut-off value and area under the curve (AUC) of Aspergillus IgG and IgM antibodies were further obtained by receiver operating characteristic (ROC) curves. Results: The positive rate of the G test, Aspergillus IgG antibody detection and the GM test also showed notable differences among the IPA, CPA, community-acquired bacterial pneumonia and healthy groups (P = 0.006, P < 0.001 and P = 0.217, respectively). Only the positive rate of the GM test showed a significant difference between the IPA and CPA groups (P = 0.04). ROC curves indicated that Aspergillus IgG antibody detection had a higher specificity in the IPA group than in the CPA group (0.952). The detection of Aspergillus IgG antibody can preferably distinguish IPA from community-acquired bacterial pneumonia and healthy controls (sensitivity = 0.923, specificity = 0.459, cutoff value = 134.46, AUC = 0.727). It can also distinguish CPA from community-acquired bacterial pneumonia and healthy controls (sensitivity = 0.952, specificity = 0.692, cut-off value = 75.46, AUC = 0.873). Conclusions: Serum Aspergillus IgG antibody detection may have certain clinical value in the diagnosis of IPA and CPA in non-agranulocytic patients.

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Chronic pulmonary aspergillosis update: A year in review

Cited by 57 publications

References 43 publications

Advances in the Diagnosis and Management of Pulmonary Aspergillosis

Advances in the Diagnosis and Management of Pulmonary Aspergillosis

CPAnet Registry—An International Chronic Pulmonary Aspergillosis Registry

Potential value of serum Aspergillus IgG antibody detection in the diagnosis of invasive and chronic pulmonary aspergillosis in non-agranulocytic patients

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